Aid workers wearing protective suits in West Africa in August 2013. (European Commission DG ECHO )
Steven VanRoekel has dedicated his career to developing and communicating complex technologies, whether at Microsoft or the federal government. But this past Fall, he faced his biggest challenge yet: To use the simplest technology available to help combat the Ebola epidemic in West Africa.
In September of 2014, VanRoekel left his post as Chief Information Officer (CIO) at the White House to join USAID, the government agency responsible for administering aid to civilians overseas. VanRoekel was charged with coordinating the U.S. government's response to the Ebola outbreak. He worked at USAID until mid-March, when he announced that he would be leaving to spend more time with family.
When he first took on the job, the Ebola crisis seemed to have no end in sight. Today, rates of new infections are starting to wind down. New Ebola cases continue to be reported in Guinea and Sierra Leone, but the situation has vastly improved in Liberia, where no confirmed cases have been reported in over a month. In about a year, the disease has claimed over 10,000 lives in West Africa, making it the largest Ebola epidemic in history.
I sat down with VanRoekel at the tech conference SXSW in Austin, Texas earlier this month and asked him about his experience using simple technologies to fight Ebola in West Africa.
Can you recall what it was like to fly into the midst of an Ebola outbreak when you first visited West Africa?
My first visit to West Africa during the midst of the crisis was a trip to neighboring Ghana to attend a two-day planning session with the United Nations. Ghana had not seen a case of Ebola at that time, but you could feel the fear in the air. My next trip, a few weeks later, was to Monrovia, Liberia. There were active cases in the city, Ebola Treatment Units on the way to the city from the airport, and the precautions were even more intense. You had to wash your hands in bleach water before entering any establishment, including restaurants, hotels and meeting places, have your temperature taken, and there was no physical contact of any kind. It is pretty weird when you meet someone to not shake their hand, but that was the norm in Liberia.
In Liberia we were all in it together, so there was really no stigma to this behavior. The stigma really came flying back to the States. The airline employees all wore rubber gloves and you could tell they were afraid to be working around you. The customs people in the United States were terrific, as were the public health officials, but you had this real fear for three weeks that you may have somehow contracted Ebola. We now know that it is much harder to transmit than we all thought in the early Fall.
Were new consumer technologies, like virtual conferencing services for doctors or health tracking wearables, relevant in this crisis?
You're lucky if you get a 2G connection in some parts of West Africa. We did set up call centers, so we could provide communication tools at scale. We also did work with communication technology providers in the region, like Facebook's nonprofit Internet.org and [Microsoft cofounder] Paul Allen. We also talked to Google, which is doing work around 'launchable' communications services like Project Loon.
As for wearables, they can also be very applicable, but more so in the care setting -- both for monitoring patients as well as monitoring health workers. This did not play a big role in the epidemic, but we made advances in this space, like this smart band, that will be applicable to future crisis.
In Africa, mobile phone usage has been exploding. How did your team take advantage of the new opportunities for SMS communications?
The growth of mobile in remote parts of the world, including West Africa, has been profound in the last decade. You can certainly find at least a few people who have a phone in very remote areas. These phones are typically simple voice and text phones, not smart devices, and there is a booming business model around pay-as-you-go services. People visit these little wooden kiosks in their village and buy a “scratch card” that gives them a code for minutes on their phones. Where mobile comes into play in this environment is the use of minimally-viable solutions, namely using voice and SMS to both communicate out, like messaging to people what symptoms to look for or how to get help, as well as to provide services where people can report cases. There is a wonderful emerging suite of tools that exist to do this data collection. One of the coolest is the MHERO suite created by UNICEF.
Speaking of communications challenges, how were you able to pull together patient records and track the spread of the disease?
That's what a big part of our work was about. When I started, we had a lot of confusion in the field because case loads were going up so rapidly. What we did -- and by 'we', I mean the global response teams -- was to kick off an effort to get data harmonized and make it operational. During my first trip to Liberia, we worked with the health ministry to create a structure where people in the field could manually collect data.
How would that work in practice?
We trained 10,000 people to collect data in paper formats, until it got to the Ministry of Health in Liberia. Our health workers would answer questions like, 'Are they probable or confirmed?' What are the symptoms?' Who have they been in contact with?' We then looked at the trends to find correlations like whether more men were getting it than women, or whether there was any correlation with the sex trade. Every day at around 4.30pm, we held a situation meeting where this data would be presented and argued about. We asked, 'What was the story behind the numbers?' We learned that about 70 percent of those who got infected were touching dead bodies. You're most infectious when you die. But there are cultural practices about hugging a loved one after they had passed. We had to get the word out.
Where does this effort go from here?
We need this data to continue to flow. We hope this is a model for the U.S. and other countries where some health data is trapped. Our vision is that by having open medical data systems that work across the vast variability of the operating environment, including a low- or no-connectivity dirt floor clinic with illiterate staff. You could create a world where you would not only have early warnings of issues arising in remote areas, but you could address those quickly and stop disease before it becomes a crisis. USAID is working on convening the community to make this a reality in West Africa and hopefully a platform for bio-surveillance around the world.
This interview has been condensed and edited for brevity.
It is the first in an occasional Q&A series for KQED's Future of You, where we interview influential people working at the intersection of healthcare and technology.
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